Provider Demographics
NPI:1568792661
Name:FRIEND, SHANNON CASEY ILENE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CASEY ILENE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17999 W SURPRISE FARMS LOOP S
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-6641
Mailing Address - Country:US
Mailing Address - Phone:623-876-7350
Mailing Address - Fax:
Practice Address - Street 1:17999 W SURPRISE FARMS LOOP S
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-6641
Practice Address - Country:US
Practice Address - Phone:623-876-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA63142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant